A model core curriculum proposed by the government in 2001 outlined the core structure for undergraduate medical education, in which a kampo medicine educational program was established to teach holistic medicine. Eighty Japanese medical schools have attempted to implement this program. We presented lectures on kampo herbal medicine as part of practical training in kampo focusing on clinical pharmacology and using a team-based format. This experience-based program aims to promote active learning of kampo herbal medicine among students. 1) After 116 4th-year students at Tokai Medical University had listened to 6 units of general lectures on the basic theory of kampo medicine, they received practical training comprising 3 units of kampo medical practice, acupuncture, and kampo herbal medicines in small groups of approximately 13 students (12 students, 3 groups; 13 students, 4 groups; and 14 students, 2 groups).2)For experience-based learning about kampo herbal medicine, each group was divided into 2 teams of students who practiced and worked on assignments so that they could understand herbal medicine from the viewpoints of both physicians and patients.3) By preparing keishito using Cinnamomi Cortex, whose production areas and quality differ, students learned the fundamental mechanism of kampo medicine through team discussions of their subjective sensory assessment of the herbal medicine keishito and the objective analysis of the main ingredients of Cinnamomi Cortex. 4) Group A (40 students, 6 teams) took the examination 2 days after the practice, and group B (76 students, 12 teams) took the exam before the practice. Group A did not show any correlation between examination results and interest levels in kampo herbal medicine, and all students but 1 correctly answered 60% or less of the questions. Group B showed a positive correlation between interest levels and examination results, and 6 students correctly answered less than 60% of the questions.5)The present practice could be effective in motivating students in kampo medicine.

We report the case of a 33-year old man with ulcerative colitis and attacks of melena who responded positively to a change in prescription, in accordance with change in his disease state. His melena developed in May of the year XXXX. He was diagnosed with ulcerative colitis (proctitis) after a thorough evaluation at another medical institution, administration of 5-ASA, steroid suppositories and an antidiarrheal agent had brought no relief, and he consequently sought Kampo treatment at our institution. Saireito (9.0g/day) and kyukikyogaito(9.0g/day) extract granules were initially administered for two weeks in addition to the aforementioned drug therapy, which resulted in improvement of his melena. However, the same Kampo formulations prescribed later, when his attacks recurred, failed to effectively halt rectal bleeding. These recurrent attacks differed from his first, in that blood was seen after the elimination of feces (feces first, blood later), and as “feces-first, blood-later” conditions are described in the Synopsis of the Golden Chamber as “enketsu” indications for odoto decoction, his prescription was changed to odoto. After odoto administration for 2 months, his melena gradually resolved, and active rectal inflammatory change was improved as seen with colonoscopy. His melena then lessened after 1 month's administration, and symptoms of melena had almost completely disappeared after 2 month's administration. Amelioration of active rectal inflammatory change was also confirmed with colonoscopy findings. This was an interesting case where the progression of a clinical condition required a corresponding change in prescription for effective management of symptoms.

Introduction: Tramadol (TRM) has been included as a weak opioid at the second step of the WHO analgesic ladder and has been widely used in palliative medicine. Here we report a case of amelioration of cancer pain by TRM therapy in a female patient with myasthenia gravis (MG). Case:The patient was a 70’s woman who was diagnosed with advanced endometrial carcinoma and suffered from chest pain caused by chest metastasis. 25 mg of a TRM capsule was orally administered three times a day. The dose was increased to 50 mg twice a day. It was resulted in sound pain relief with transient muscle weakness but without a myasthenic crisis.